Cardiac tamponade.

Cardiac tamponade, a potentially lethal complication following cardiac surgery may not away either early or late postoperatively and may be difficult to diagnose fit to atypical clinical, hemodynamic, or echocardiographic findings. To determine the frequent occurrence and clinical features of postoperative cardiac tamponade, we performed a review of 510 consecutive patients who underwent cardiac surgery The incidence of postoperative cardiac tamponade was 20 percent (10/510 patients) and occurr following valvular, bypass, and aortic surgery Nine of ten patients had either atypical clinical, hemodynamic, and/or echocardiographic findings. The diagnosis of tamponade was made 1 to 30 days (mean = 85 days) postoperatively. Presenting symptoms were oftentimes mild and nonspecific. Classic signs including hypotension, pulsus paradoxus greater than 12 mm Hg and elevated jugular venous compressing were present in 7, 6 and 5 patients, respectively. Right heart hemodynamics revealed elevated and equalized diastolic constraining forces in three of six patients. Two-dimensional echocardiography revealed selective compression of the left ventricle (LV) (four patients), right ventricle (RV) (one patient), left atrium (LA)/RV (one patient), LA/LV (one patient), LA/LV/RV (one patient), all four chambers (one patient), and no diastolic collapse of any chamber (one patient). There was frequently an absence of anterior pericardial fluid (six patients) with tethering of a portion of the RV to the chest wall anteriorly (five patients). Coagulation parameters were "supratherapeutic" in solely three of eight patients who were receiving systemic anticoagulants at the time of diagnosis. The initial diagnosis was confused with congestive heart failure in the same patient, pulmonary embolism in three patients, acute myocardial infarction in sum of two units patients, and sepsis in the same patient. Eight of ten patients survived; all of these patients underwent surgical removal of fluid and/or hematoma in the operating swing We conclude that postoperative tamponade after cardiac surgery may have varied clinical and hemodynamic presentations, oftentimes due to selective chamber compression on loculated fluid or clot. to be paid to its frequently atypical features and presentation that may simulate other disorders, the diagnosis of tamponade should be considered whenever hemodynamic deterioration or signs of grave output failure occur in the postcardiotomy patient.

Cardiac tamponade is a potentially lethal complication after cardiac surgery and may come into one's head in both the early and late postoperative periods. The incidence of cardiac tamponade after coronary artery bypass or open-heart surgery is reported to be 05 to 58 percent[1-6] The majority of these cases present itself in the very early postoperative period and are relatively easy to diagnose while the patient is still below close hemodynamic observation. "Delayed" or "late" cardiac tamponade has been arbitrarily defined in the literature as that occurring greater than 5 to 7 days after cardiac surgery and has been reported to come to one's mind up to 6 months[10] postoperatively. Using this definition, the incidence of delayed cardiac tamponade is reported to be 03 to 26 percent[257-14] Tamponade that befalls very late after cardiac surgery especially after hospital discharge, is more likely to be misdiagnosed appropriate to the low index of suspicion and lack of general awareness of this entity occurring weeks or month postoperatively.

We performed a review of patients who underwent cardiac surgery and establish ten cases of documented postoperative cardiac tamponade. Using the previous definition of delayed tamponade, five or six of our cases would be classified as late or delayed tamponade. Nine of ten patients had atypical clinical, hemodynamic, and/or echocardiographic findings. individual patient developed "typical" signs and symptoms of tamponade, on the other hand this did not occur until 1 month following cardiac surgery We describe the clinical, hemodynamic, and echocardiographic findings seen in these postoperative patients.

METHODS

Patient Population

We performed a retrospective review of 510 patients who underwent cardiac surgery between October 1989 [i]or[/i] part of to the other November 1990 at Cooper Hospital/University Medical Center in Camden, NJ This included patients who underwent cardiac valve surgery coronary artery bypass surgery or other cardiothoracic surgery including thoracic aortic aneurysm repair. Ten of 510 patients (20 percent) had the diagnosis of cardiac tamponade remind ofed by echocardiography and documented according to rapid relief of symptoms or reversal of hemodynamic instability immediately following drainage of pericardial fluid. All patients who had transthoracic and/or transesophageal echocardiography performed prior to reoperation were included in this inquiry Patients who returned to the operating scope within the first 24 h after surgery for chest tube bleeding alone, without echocardiographic documentation of pericardial fluid accumulation, were exclud from this analysis. Of these ten patients, three patients underwent coronary artery bypass grafting (CABG) alone, four patients underwent aortic valve replacement (AVR) or mitral valve replacement (MVR) alone, sum of two units patients underwent AVR and CABG, and common patient underwent repair of a chronic adumbration A aortic dissection. At our institution, the anterior pericardium is left render free of access in patients following CABG and is reapproximated in patients undergoing valvular surgery alone.

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